With one devastating flourish of the presidential pen, worldwide progress on family planning, population growth and reproductive rights was swept away. Now some of the world’s poorest women must count the cost.

Six months ago, one powerful white man in the White House, watched by seven more, signed a piece of paper that will prevent millions of women around the world from deciding what they can and can’t do with their own bodies.

In that moment, on his very first Monday morning in office, Donald Trump effectively signed the death warrants of thousands of women. He reversed global progress on contraception, family planning, unsustainable population growth and reproductive rights. His executive order even has implications for the battle against HIV, tuberculosis and malaria.

Rarely can the presidential pen have been flourished to such devastating effect. The policy it reintroduced will shut health clinics in Uganda and HIV programmes in Mozambique; it will compel women from Nepal to Namibia to seek out deadly back-street abortions.

“It is an unprecedented attack on women’s rights – it goes much deeper than abortion,” said Ulla Müller, president and CEO of EngenderHealth, a leading advocacy organisation.

“Girls are kicked out of school if they get pregnant. They are very often forced to marry the fathers. Very often they have to live in their in-laws’ house, where they have to do unpaid labour. It is a violation of women’s rights. We need to see this as a gender issue and very much as a power issue.”

Tewedros Melesse, director general of the the International Planned Parenthood Federation (IPPF), which stands to lose as much as $100m, said the US move “seeks to restrict the rights of millions of women. It asks us as a health provider, to stop providing services which are entirely legal in countries through our members – where some of the most poorest women, depend on them.

“The human cost of the gag rule will have a long and fatal legacy.”

Like so many far-reaching American policies, Trump’s executive order is enshrouded in complexity to the point where it seems almost designed to confuse.

The order reinstated the Mexico City policy (so called because it was first signed at the International Conference of Population in Mexico City, in 1984). Under this policy, any NGO outside the US seeking American funding for family planning has to pledge it will not carry out abortions anywhere in the world, even with its own money. Such organisations must agree not to talk to women about a termination, nor lobby governments to liberalise their policy on abortion.

US aid has never been used to fund abortion services (it is forbidden, by law). This is a ban on speaking about abortion – a restriction on free speech which the First Amendment does not permit within the US. For this reason, the rule became known as the global gag.

Trump’s version of the policy has massively expanded its reach. It is no longer just international family planning organisations that must agree not to “perform or actively promote abortion”. Every global health organisation that accepts US funding now has to sign the same clause. Anyone working to fight HIV, get vaccines or vitamins to children, or prevent Zika or malaria is facing a stark and unprecedented choice: sign, or lose all funding from the biggest aid donor in the world.

As much as $10bn (£7.7bn) of global health funding hangs in the balance. Among those who will lose money if they refuse to sign up to the anti-abortion orthodoxy are the two big international family planning organisations, Marie Stopes International (MSI) and the IPPF. But for the first time, global NGOs such as Save the Children, WaterAid and the International HIV/Aids Alliance are also targeted.

The effects will be felt most keenly in the tiny, frontline clinics run by small NGOs struggling to help women and children in crowded townships, refugee camps and remote rural villages. There are no abortion doctors in such places (in most African countries, abortion is banned unless the woman’s life is in danger). These clinics instead offer contraceptive injections and condoms for those who would struggle to feed numerous children. But they also treat children for malaria and malnutrition and their mothers for HIV. This integrated care is now under threat.

But that’s not all. Trump has also decided to stop funding the UN Population Fund, which does hard and heroic work, reaching some of the most oppressed women in the world in refugee camps and war zones, as well as getting contraception to the remotest parts of the planet. In 2016, the US gave the organisation $69m in core funds and for its humanitarian response work.

PS This is power and control over half of the human population in the World–Women. The Republicans and others are determined to keep women away from competing with males in the work place by keeping us, in our prime, pregnant every year, stuck at home taking care of the household, hubby and the children which is unpaid labor or a servant for life. It worked for years and the males want it back. This is a sure fire way of leveling the playing field, keeping women from earning a good living and therefor being completely dependent on their husbands or fathers. Think about it. It’s diabolical. We don’t want to go back to the 1950’s–time for a change.

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